Provider Demographics
NPI:1245332352
Name:GUPTA, VEENA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FAWN LN
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1126
Mailing Address - Country:US
Mailing Address - Phone:914-273-0274
Mailing Address - Fax:914-273-2648
Practice Address - Street 1:3130 GRAND CONCOURSE
Practice Address - Street 2:#1G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1213
Practice Address - Country:US
Practice Address - Phone:718-733-5299
Practice Address - Fax:718-733-2870
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011823922Medicaid
NY47F801Medicare ID - Type Unspecified
NY011823922Medicaid